Knowledge, awareness and use of HIV services among the youth from nomadic and agricultural communities in Tanzania.

BACKGROUND: Nomadic life not only prevents the community from accessing and utilising HIV services but also deters them from obtaining reliable information on HIV. METHODS: We conducted a cross-sectional study of youth aged 10-24 years from the Kilindi and Ngorongoro Districts in Tanzania to assess knowledge, accessibility and utilisation of HIV/AIDS services among nomadic and agricultural youths. RESULTS: Of 518 youths interviewed, 279 (53.9%) were males, and 276 (53.3%) were from agricultural communities. A significant proportion of youths from agricultural communities had correct knowledge of AIDS (n = 126, 45.8%; P = 0.002), HIV transmission (n = 273, 98.9%; P = 0.001) and comprehensive knowledge of HIV/AIDS (n = 78, 28.5%; P = 0.009) compared to nomads. Youths from agricultural communities were two times (OR 1.8, 95% CI 1.2-2.6) more likely to be aware of the availability of formal HIV services. Awareness of the availability of HIV services was higher among married individuals than in unmarried ones (OR 3.8, 95% CI 2.0-7.4), and significantly higher among youths with secondary/college education than in those who did not have formal education (OR 5.3, 95% CI 2.3-12.4). The uptake of HIV services was lower among nomadic youths. CONCLUSION: Knowledge, awareness and utilisation of HIV/AIDS transmission services were low in general, and even lower among nomadic youths, calling for more targeted interventions.

CONTEXTE: La vie nomade n'entrave pas seulement l'accès et l'utilisation des services VIH par une communauté mais empêche également l'accès à une information VIH fiable. MÉTHODES: Nous avons réalisé une étude transversale auprès de jeunes de 10­24 ans des districts de Kilindi et de Ngorongoro en Tanzanie pour évaluer les connaissances, l'accessibilité et l'utilisation des services VIH/SIDA parmi les jeunes nomades et agriculteurs. RÉSULTATS: Sur 518 jeunes, 279 (53,9%) étaient des garçons, 276 (53,3%) venaient de communautés agricoles. Une proportion significative des jeunes de communautés agricoles avaient des connaissances correctes en matière de SIDA (n = 126 ; 45,8% ; P = 0,002), de transmission du VIH (n = 273 ; 98,9% ; P = 0,001) de connaissances complètes du VIH/SIDA (n = 78 ; 28,5% ; P = 0,009) comparées à celles des nomades. Les jeunes des communautés agricoles étaient deux fois plus au courant (OR 1,8 ; IC 95% 1,2­2,6) de la disponibilité de services VIH formels. La connaissance de la disponibilité de services VIH était plus élevée chez les jeunes mariés (OR 3,8 ; IC 95% 2,0­7,4) comparés aux célibataires, et significativement plus élevée parmi les jeunes ayant eu une instruction secondaire/supérieure comparés à ceux qui n'avaient eu aucune éducation formelle (OR 5,3 ; IC 95% 2,3­12,4). L'utilisation des services VIH était plus faible parmi les nomades. CONCLUSION: Les connaissances, la sensibilisation et l'utilisation des services de transmission du VIH/SIDA étaient bas et encore plus bas chez les jeunes nomades, appelant des interventions plus ciblées.

Xpert® MTB/RIF assay testing on stool for the diagnosis of paediatric pulmonary TB in Tanzania.

SETTING: Six health facilities in Dar es Salaam, Tanzania. OBJECTIVE: To evaluate the use of stool specimens in the diagnostic workup of paediatric TB using the Xpert® MTB/RIF assay. DESIGN: Between December 2018 and May 2019, we performed a cross-sectional diagnostic study of children aged between 1 month and 14 years with presumptive TB. A single stool specimen was tested using Xpert. The result was compared with the reference microbiological standard for respiratory or gastric specimens tested using Xpert and/or solid culture. The sensitivity, specificity and predictive values of stool Xpert assay were assessed. RESULTS: A total of 225 children with a median age of 2.17 years (IQR 1.16-5.19) were enrolled; 165/225 (73.3%) were aged <5 years. Of 225 children, 8 (3.6%) were diagnosed with TB as they were culture- or Xpert-positive on sputum/gastric aspirate. The stool Xpert assay showed a sensitivity of 62.5% (95% CI 25-92) and specificity of 100% (95% CI 98-100) against the reference standard. CONCLUSION: Use of the Xpert assay on stool specimens had a moderate sensitivity and high specificity in the diagnosis of pulmonary TB in children. Our data adds to the body of evidence for the use of Xpert assay on stool as a non-respiratory specimen to complement conventional methods used to diagnose the disease.

CONTEXTE: Six structures de santé à Dar es Salaam, Tanzanie. OBJECTIF: Evaluer l'utilisation d'échantillons de selles dans le bilan diagnostique de la TB pédiatrique en utilisant le test Xpert® MTB/RIF. SCHÉMA: Entre décembre 2018 et mai 2019, nous avons réalisé une étude transversale de bilans d'enfants âgés d'un mois à 14 ans avec la TB présumée. Un échantillon unique de selles a été testé par l'Xpert. Le résultat a été comparé avec comme référence le standard microbiologique d'échantillons respiratoires ou gastriques testés par test Xpert et/ou culture solide. La sensibilité, la spécificité et les valeurs prédictives de l'Xpert sur les selles ont été évaluées. RÉSULTATS: Ont été enrôlés 225 enfants d'âge médiane 2,17 ans (IQR 1,16­5,19) dont 165 (73,3%) avaient moins de cinq ans. Huit (3,6%) enfants ont eu un diagnostic de TB par culture ou test Xpert positif sur aspiration de crachats/gastrique. Le test Xpert sur les selles a montré une sensibilité de 62,5% (IQR 25­92) et une spécificité de 100% (IQR 98­100) vis-à-vis du standard de référence. CONCLUSION: Le recours au test Xpert sur des échantillons de selles a montré une sensibilité modérée et une spécificité élevée dans le diagnostic de la TB pulmonaire des enfants. Nous données confirment l'intérêt de l'utilisation du test Xpert sur les selles comme échantillon non respiratoire pour compléter les méthodes conventionnelles de diagnostic de la maladie.

Clinical implication of novel drug resistance-conferring mutations in resistant tuberculosis.

Evolving novel and/or unfamiliar mutations are revolutionizing the pathways of antibiotic resistance of clinical tuberculosis. The accumulation and interaction of these poorly characterized mutations augment the complexity of resistant pathogenic strains and raise public health concerns. This article reviews our current understanding of the genetic changes that characterize drug resistance in tuberculosis and highlights the imperative for further investigations focusing on the effects of an individual mutation and interacting mutations with detailed strain epidemiology, particularly as these pertain to technology-limited countries with high tuberculosis incidence rates. Concomitantly, there is a need for the development, testing, and uptake of new tools for studying the effects of these mutations in drug resistance and fitness cost of the pathogen. Such genetic data are critical for effective localized and global tuberculosis control interventions and for accurate epidemiological predictions.

A field vaccine trial in Tanzania demonstrates partial protection against malignant catarrhal fever in cattle.

Malignant catarrhal fever (MCF) is a fatal lymphoproliferative disease of cattle that, in East Africa, results from transmission of the causative virus, alcelaphine herpesvirus 1 (AlHV-1), from wildebeest. A vaccine field trial involving an attenuated AlHV-1 virus vaccine was performed over two wildebeest calving seasons on the Simanjiro Plain of northern Tanzania. Each of the two phases of the field trial consisted of groups of 50 vaccinated and unvaccinated cattle, which were subsequently exposed to AlHV-1 challenge by herding toward wildebeest. Vaccination resulted in the induction of virus-specific and virus-neutralizing antibodies. Some cattle in the unvaccinated groups also developed virus-specific antibody responses but only after the start of the challenge phase of the trial. PCR of DNA from blood samples detected AlHV-1 infection in both groups of cattle but the frequency of infection was significantly lower in the vaccinated groups. Some infected animals showed clinical signs suggestive of MCF but few animals went on to develop fatal MCF, with similar numbers in vaccinated and unvaccinated groups. This study demonstrated a baseline level of MCF-seropositivity among cattle in northern Tanzania of 1% and showed that AlHV-1 virus-neutralizing antibodies could be induced in Tanzanian zebu shorthorn cross cattle by our attenuated vaccine, a correlate of protection in previous experimental trials. The vaccine reduced infection rates by 56% in cattle exposed to wildebeest but protection from fatal MCF could not be determined due to the low number of fatal cases.